Provider Demographics
NPI:1992109037
Name:JUNGHANS-RUTELONIS, ASHLEY (PHD)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:
Last Name:JUNGHANS-RUTELONIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:JUNGHANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 51
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:MN
Mailing Address - Zip Code:55386-0051
Mailing Address - Country:US
Mailing Address - Phone:952-443-4600
Mailing Address - Fax:952-443-4604
Practice Address - Street 1:15265 CARROUSEL WAY STE 100
Practice Address - Street 2:
Practice Address - City:ROSEMOUNT
Practice Address - State:MN
Practice Address - Zip Code:55068-1760
Practice Address - Country:US
Practice Address - Phone:952-443-4600
Practice Address - Fax:952-443-4604
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program